Use of Situational Vignettes Helps Assess the Competence of Frontline Workers (FLW) in Nutrition Counseling Programs (OR13-07-19)

Behavior change communication (BCC) effectiveness depends on the knowledge of frontline workers (FLWs) who counsel clients. Most studies assess content-based knowledge of FLWs but do not examine their ability to apply this content. We tested the use of situational vignettes to assess ‘application knowledge’ and examined gaps between content and application knowledge, and the association between both types of FLW knowledge and that of clients (mothers). Data are from a survey of 100 FLWs and 409 mothers with children <2y in Madhya Pradesh, India. Content knowledge was assessed using questions on nutrition. Application knowledge to assess FLW knowledge of topics to cover in specific counselling contacts was measured using situation-based vignettes and follow-up questions. Gap was defined as FLW demonstrating content knowledge without application knowledge. Regression models were used to assess determinants of knowledge, gaps in types of knowledge and associations with mothers’ knowledge. Many FLWs had reasonable content knowledge of family planning (94%), iron-folic acid during pregnancy (68%) and exclusive breastfeeding (93%). However, vignette-based application knowledge was lower than content knowledge. FLW education was associated with higher content knowledge (β = 0.69; P < 0.05) and higher application knowledge (β = 1.08; P < 0.01) of FLWs. FLWs’ age and caste were associated with gaps between content and application knowledge (β = 0.03 and β = 0.51, P < 0.10). The magnitude of association of FLWs’ application knowledge with maternal knowledge (β = 0.07; P < 0.10) was nearly twice the association of FLWs’ content knowledge with maternal knowledge (β = 0.04; P < 0.10), adjusted for maternal characteristics. Assessing application-based knowledge using situational vignettes was feasible and helped understand FLW competence more than content-based knowledge tests only. Counseling programs must strengthen both content and application knowledge. Bill & Melinda Gates Foundation through POSHAN, led by International Food Policy Research Institute.